- LA Care Health Plan (Los Angeles, CA)
- … is responsible for various tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans contracted ... requirements. Communicate issues and findings that would affect the audit results. Perform claims audits for all medical groups and health plans contracted… more
- Providence (CA)
- …organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending ... to department leaders for claims management improvement opportunities and claims -related trends through audit , data analytics, and training observations +… more
- Conduent (Los Angeles, CA)
- … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
- Sedgwick (Ontario, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead - Workers Compensation **PRIMARY PURPOSE:** To supervise the operation… more
- Sedgwick (Long Beach, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Best Workplaces in Financial Services & Insurance Workers Compensation Claims Supervisor | Long Beach, CA (Hybrid) | SIP...Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +… more
- The Walt Disney Company (Burbank, CA)
- …exhibitor-proposed programs such as subscriptions, and actively assisting in settling audit claims through detailed analyses and presentation decks. The ... audits (ie, subscriptions, early birds, mid-week, etc). Supports the settling of audit claims and estimates potential future audit claims by… more
- Ross Stores, Inc. (Dublin, CA)
- …to remain well informed on industry trends, court decisions impacting lease audit claims , opportunities in technology, and the capabilities of third\-party ... all occupancy expenses payable to landlords\. Accountable for the entire lease audit function from claim identification to dispute resolution\. Manage third party… more
- Prime Healthcare (Ontario, CA)
- … Claims for all Prime Healthcare's self-insured Employee Health Plans. Through in-depth audit and review of Claims data, the VP will identify financial ... Ontario, California. TheVice President of Health Plan Operations and Claims is responsible for the development and execution of...Health Plans. The VP of Health Plan Operations and Claims will provide strategic leadership and development of the… more
- Highmark Health (Sacramento, CA)
- …the consistent, accurate, efficient, and appropriate processing of adjustments and/or duplicate claims through an audit sampling review process. 2. Develop ... data relevant to the handling of all types of complex adjusted claims ; conducting reviews of all organizational or functional activities related to fraud/abuse… more
- WTW (Los Angeles, CA)
- …+ **Conduct stewardship client meetings, assist underwriting in their renewal process, audit claims performance against best practices, and implement value added ... **Be responsible for the overall technical, financial, service, and audit performance and results of the partner TPA at...degree or equivalent with ten or more years of claims servicing and technical experience.** + **Knowledge at the… more